Association of dietary patterns with obesity and metabolically healthy obesity phenotype in Chinese population: a cross-sectional analysis of China Multi-Ethnic Cohort Study

Metabolically healthy obesity (MHO) might be an alternative valuable target in obesity treatment. We aimed to assess whether alternative Mediterranean (aMED) diet and Dietary Approaches to Stop Hypertension (DASH) diet were favorably associated with obesity and MHO phenotype in a Chinese Multi-Ethnic population. We conducted this cross-sectional analysis using the baseline data of the China Multi-Ethnic Cohort (CMEC) study that enrolled 99 556 participants from seven diverse ethnic groups. Participants with self-reported cardiometabolic diseases were excluded to eliminate possible reverse causality. Marginal structural logistic models were used to estimate the associations, with confounders determined by directed acyclic graph (DAG). Among 65 699 included participants, 11.2% were with obesity. MHO phenotype was present in 5.7% of total population and 52.7% of population with obesity. Compared with the lowest quintile, the highest quintile of DASH diet score had 23% decreased odds of obesity (OR = 0.77, 95% CI: 0.71-0.83, Ptrend <0.001), and 27% increased odds of MHO (OR = 1.27, 95% CI: 1.10-1.48, Ptrend =0.001) in population with obesity. However, aMED diet showed no obvious favorable associations. Further adjusting for BMI did not change the associations between diet scores and MHO. Results were robust to various sensitivity analyses. In conclusion, DASH diet rather than aMED diet is associated with reduced risk of obesity and presents BMI-independent metabolic benefits in this large population-based study. Recommendation for adhering to DASH diet may benefit the prevention of obesity and related metabolic disorders in Chinese population.